Enterovirus D68

1. What are enteroviruses?

Enteroviruses (EV) are common viruses; there are more than 100 types. It is estimated that 10-15 million EV infections occur in the US each year. Most people infected with EV have no symptoms or only mild symptoms, but some infections can be serious. The spread of EV is unpredictable and different types of EV can be common in different years with no pattern. People are more likely to get infected with EV infections in the summer and fall.

In
August, severely ill children with EV were reported in Missouri and
Illinois. The EV strain (type) was identified as D68 by the Centers for
Disease Control and Prevention (CDC). Among the EV-D68 cases in Missouri
and Illinois, children with asthma seemed to have a higher risk for
severe respiratory illness. The CDC is currently working with state
health departments to determine the exact risk factors for EV-D68. More
than 40 states have confirmed respiratory illness caused by EV-D68.

The
CDC has received more specimens for EV lab testing than usual this year.
More than 1,000 specimens have been tested by the CDC lab. Of those
tested, about half have tested positive for EV-D68. About 1/3 have
tested positive for other viruses, such as rhinovirus or enteroviruses
other than EV-D68.

Does the CDC have plans to make EV-D68 testing quicker in the future?

The
CDC has developed a faster lab test for detecting EV-D68. CDC will
begin using this new test on October 14, 2014, which will allow them to
process specimens more quickly. As a result of this faster test, the
number of confirmed EV-D68 cases will likely increase in the coming
days. These increases do not mean the situation is getting worse. Faster
testing will help to better show the trends of this outbreak and
monitor changes occurring in real time.

What are symptoms of EV-D68 infection?

Symptoms may range from
mild to severe. Mild symptoms may include runny nose, sneezing, cough,
body and muscle aches and sometimes fever. Severe symptoms include
difficulty breathing, wheezing and worsening of asthma. Hospitalization
in an intensive care unit may be required.

How is EV-D68 infection spread?

EV-D68 is spread through close
contact with infected people. Enteroviruses can be found in respiratory
secretions, such as saliva (spit), nasal mucus (snot) and sputum (thick
mucus in the lungs) and stool (poop). The virus likely spreads from
person to person when an infected person coughs or sneezes and you can
also become infected by touching objects or surfaces that have the virus
on them and then touching your mouth, nose or eyes and when a person
touches poop and does not wash their hands.

Infants, children and teenagers are
most likely to get infected with EV and become sick. This is most likely
because they do not have protection (immunity) or because of no
previous exposure to this virus. Children with asthma seem to have a
higher risk for severe respiratory illness. Infants and people with
weakened immune systems have a greater chance of complications. Adults
can get infected with EV and are more likely to have no symptoms or mild
symptoms.

How is EV-D68 diagnosed?

EV-D68 can only be diagnosed by doing
specific lab tests on specimens (samples) most often taken from a
person’s nose and throat. Many hospitals and some doctor’s offices can
test ill patients to see if they have an EV infection. However, most
cannot do specific testing to determine the type of EV, like EV-D68. In
New Jersey, samples are sent to the CDC to determine the type of EV. The
CDC is receiving samples from all over the country and it is impossible
to predict how quickly testing can be completed.

How are samples/specimens tested?

Since knowing the answer to
exactly what virus is causing an illness is not necessary for treatment,
testing to determine if EV-D68 is the cause of an illness is usually
not done. If your doctor and the New Jersey Department of Health (NJDOH)
feel that it is important for this testing to be done, the NJDOH can
arrange for a specimen to be sent to the CDC. The NJDOH has criteria in
place for testing specimens, since the virus has already been confirmed
in our state. However, it takes days to weeks to get the results of
these tests.

Can individual doctors and hospitals confirm cases of EV-D68?

EV-D68
can only be diagnosed by doing specific lab tests on specimens
(samples) and that few laboratories are able to perform. While many
hospitals and some doctor’s offices can test ill patients to see if they
have an EV infection, very few can do specific testing to determine the
type of EV, like EV-D68. There are over 100 EV infections and specific
typing of specimens is needed to confirm whether the virus is D68. In
order to make the final diagnosis of EV-D68, the CDC in Atlanta would
have to confirm the test on the sample.

How is EV-D68 treated?

There is no specific medication for
EV-D68 infections. Antibiotics do not treat viruses, and will have no
effect on EV-D68. For most people, no treatment is needed, though
medication may help control some symptoms. Aspirin should not be given
to children. Those with severe respiratory illness may need to be
hospitalized and receive intensive care. Testing for EV-D68 does not
change the treatment an ill child will receive.

How can I protect myself from becoming infected with EV-D68?

There
is no vaccine to prevent EV-D68 infections. However, you can protect
yourself from EV-D68 and other EV infections by following the
suggestions on this page: Protection from Enterovirus D68

How long can EV live on surfaces?

EV can survive on surfaces
long enough to allow the virus to spread to others. Frequent cleaning of
commonly touched surfaces such as tables, chairs, counter tops,
doorknobs, toys and computer keyboards can help limit the spread of EV
to others.

What is the best way to clean surfaces?

The best way to clean
surfaces is to use a bleach-based household cleaner as directed on the
product label. If no such cleaning product is available, you can use a
solution made with 5 tablespoons to 1.5 cups of household bleach per 1
gallon of water. If you are unable to use bleach, look for cleaning
products that list “Alkyl dimethyl benzyl ammonium chloride” as an
active ingredient on the label and says that the product kills norovirus
and rhinovirus. This includes products such as Lysol All-purpose
cleaner, Pine-Sol All-purpose cleaner and Clorox disinfecting
spray/wipes. Follow instructions on the label. Enteroviruses are
resistant to alcohol disinfection. The Environmental Protection Agency
(EPA) website has a list of commercial cleaning products for
noroviruses; these also kill enteroviruses: EPA-Registered Disinfectants

How concerned should parents be about the EV-D68?

Enteroviruses
(EV) are common viruses with more than 100 different types that are
around mostly in the summer and fall. EV infections can cause mild or
severe symptoms, and are more common in infants, children and teenagers.
Parents who have children with asthma should make certain that their
child’s condition is well managed. All parents should encourage good
hand washing and respiratory hygiene to prevent illness. If a child
becomes ill or has difficulty breathing, parents should consult with
their health care provider.

What is respiratory hygiene?

Respiratory hygiene includes
coughing and sneezing into a tissue or arm/elbow and then properly
disposing of the tissue. Hand sanitizer is not effective against EV. For
more information about respiratory hygiene see: CDC Influenza (Flu)
Information

What is hand hygiene?

Hand hygiene refers to washing hands
often with soap and water for 20 seconds, especially after changing
diapers, touching pets and commonly touched surfaces. Avoid touching
eyes, nose and mouth with unwashed hands. Hand sanitizer is not
effective against enteroviruses.

What should parents of children with asthma know about EV-D68?

It
is important that asthma is well-treated and controlled. Children with
asthma should follow their asthma treatment plan. Healthcare providers
should be consulted in the development of asthma treatment plans.

If a child is diagnosed with EV or EV-D68, should they be excluded from school/daycare?

Children
without a fever should be excluded until symptom free. Children with a
fever (oral temperature of more than 100 degrees Fahrenheit) must stay
home until they are fever free for 24 hours without fever-reducing
medication and symptom free. For school exclusion guidance, visit this
website: Outbreaks in School and Daycare Settings

Is there a risk of my child getting EV-D68 if my child goes to school?

As
with other respiratory infections, including the flu and the common
cold, there is some increase in risk of catching the EV-D68 in places
with large numbers of people, such as schools and daycare settings.
Children can protect themselves by washing their hands often, not
touching their eyes and noses and coughing or sneezing into a tissue or
their arm/elbow and properly disposing of the tissue. Parents should
never send a sick child to school. Any child with a fever of 100 degrees
Fahrenheit or more should stay home until they are fever free for 24
hours.

What are schools doing about EV-D68?

Schools are encouraged to
be vigilant for any unexpected increase in illness among their students
and report any suspected outbreak of any illness, including EV-D68, to
their local health department.

The New Jersey Department of Health
provides general guidelines about responding to illness which may occur
in schools and daycare settings, such as exclusion criteria, prevention
and outbreak response. More information is available on the
department's website: New Jersey Department of Health Website

Why does EV-D68 seem to affect children more than adults?

Infants,
children and teenagers are most likely to get infected with EV and
become sick. This is most likely because they do not have protection
(immunity) due to no previous exposure to this virus. Children with
asthma seem to have a higher risk for severe respiratory illness.
Infants and people with weakened immune systems have a greater chance of
complications. Adults can get infected with EV and are more likely to
have no symptoms or mild symptoms.

How do I know my child’s school was cleaned?

Each school has a
regular cleaning schedule that they follow. These cleaning schedules are
designed to keep children safe. Check with your school for more
information about the cleaning schedule.

How are patients who were swabbed for EV notified whether it is EV-D68?

Patients
who were tested for EV should talk with their healthcare provider. Many
hospitals and some doctor’s offices can test ill patients to see if
they have an EV infection. However, most cannot do specific testing to
determine the type of EV, like EV-D68. In New Jersey, samples are sent
to the CDC to determine the type of EV. The CDC sends results to the New
Jersey Department of Health, who then contacts the healthcare provider.
Results can take a while to confirm the type of EV. However, testing
for EV-D68 does not change the treatment that an ill person will
receive.

Should we be testing all children to see if they have EV or EV-D68?

No.
Enteroviruses (EV) are common viruses and EV infections are more common
in the summer and fall. While some testing of sick kids can help the
local and state health departments determine how widespread this illness
is, testing of all children will not help. Since there is no treatment
for EV-D68, testing all kids will also not help the children.Testing for
EV-D68 does not change the treatment that an ill child will receive.

How can I protect myself against getting a respiratory virus?

There
are many viruses that are in the environment and people come into
contact with them every day. Enteroviruses, influenza, rhinovirus and
coxsackie viruses are common in the fall and winter months and are
spread person-to-person. The best way to protect yourself is to practice
good hand hygiene (washing hands) and respiratory hygiene (cover coughs
and sneezes with the inside of your arm or a tissue and then throw away
the tissue) and to clean commonly touched surfaces often, such as door
knobs, tables and toys. Getting a flu shot every year is also a good way
to prevent getting the flu.

Is there special concern for pregnant women and EV-D68?

Most
pregnant women will likely be exposed to many viruses, particularly in
the fall. Some of these viruses may be EV-D68. Most pregnant women who
do come into contact with EV-D68 will not get sick, or will only have a
mild illness. There is no clear evidence that EV-D68 can cause severe
complications such as miscarriage or birth defects. If the mother is
sick when she delivers, it is possible for EV to be passed from mother
to baby at birth. Often, babies born to ill mothers do not get sick.
Mothers and everyone else should practice good respiratory and hand
hygiene and clean commonly touched surfaces and items, such as toys,
doorknobs and computer keyboards.

I just heard about limb weakness of unknown causes in children. How is this related to EV-D68?

Neurologic
illness with limb weakness can result from a variety of causes. Viral
causes of neurologic illness may include viruses that cause respiratory
illness and West Nile virus. Neurologic illness caused by these viruses
is uncommon in the United States. If your child is experiencing
neurological illness with limb weakness, contact your healthcare
provider.

How can I tell the difference between an EV infection and the flu?

Many
respiratory illnesses, including the common cold, EV infection, and the
flu may have similar symptoms. When compared to EV infection, the flu
tends to hit quicker and harder, with a rapid onset of symptoms
including fever (often more than 101 degrees Fahrenheit), chills, muscle
aches, and headache. Usually, EV infection starts gradually, with
symptoms of sore throat, cough, runny nose developing over a couple of
days, and fevers are not as high as with flu. It is not possible to tell
which illness you have based on symptoms alone. If you, or a loved one,
has a severe illness - especially any illness with difficulty breathing
- seek medical attention right away.

What should healthcare providers know about EV-D68?

Clinicians
should consider EV-D68 as a possible cause of severe respiratory
illness, particularly in children. Healthcare providers should report
unusual increases in the numbers of patients with severe respiratory
illness to their local health department.

What is the New Jersey Department of Health (NJDOH) doing to respond to EV-D68?

The
NJDOH continues to monitor the situation and is in communication with
hospitals, local health departments, healthcare providers, schools and
daycare providers about testing and clinical guidance.

In
conjunction with the CDC and other partners, the NJDOH confirmed the
first case in the New Jersey resident on September 17, 2014. Once the
presence of EV-D68 is confirmed in a region, there is no need for
routine testing for this infection. Testing for EV-D68 does not change
the treatment an ill child will receive.

How many deaths does New Jersey see every year from respiratory illness?

In
New Jersey, only pediatric deaths from influenza are reportable. New
Jersey does not track pediatric deaths from respiratory illness.
However, while not common, pediatric deaths from respiratory illnesses
do occur.